The objective of this study is to improve perinatal patient safety and demonstrate the relationship to decreased malpractice activity. The proposed study intends to build on our prior efforts to eliminate preventable perinatal harm in a nationwide collaborative. We would use a prospective cohort study of 16 hospitals with a matched comparison group to implement perinatal best practices and evaluate the impact on improved patient safety and reduced malpractice activity. Combined with the interventions from the first study, we would have safety findings and claims data from 16 hospitals representing approximately 223,000 births over a total of five years. This study is led by Fairview Health Systems and is a partnership between three organizations: 1) Fairview Health Systems, one of the largest hospital systems in the Midwest, 2) The Premier healthcare alliance which provides excess professional and general liability insurance coverage for more than 100 hospitals nationally, and 3) the School of Public Health, University of Minnesota, with leading research in perinatal patient safety. The three partner organizations have substantial experience working successfully to improve perinatal patient safety. Our preliminary work, a two year collaborative (January 2008 to December 2009) was just completed which established a proof of concept. We demonstrated it is possible to work toward high reliability in perinatal units using best practices that reduce perinatal harm. While we achieved compliance improvement with three best practices (from 7 percent to 70 percent), the study duration was not long enough to achieve 90 percent or greater best practice compliance. Additional effort is needed to achieve high reliability performance. The proposed project is significant for two reasons: 1) there is little empirical evidence showing methods to improve perinatal patient safety;and 2) there are no scientific studies showing the relationship between improved patient safety and reduced obstetrical events, malpractice claims and payments. We would accomplish three goals: 1) restart the previous collaborative for an additional two years in order to achieve high reliability with best practices;2) introduce a fourth intervention involving interdisciplinary team training (using AHRQ TeamSTEPPS and in-situ simulation training);and 3) analyze the impact of the interventions on improved patient safety and reduced malpractice costs. PUBLIC HEALTH RELEVANCE: The objective of this study is to improve perinatal patient safety and demonstrate the relationship to decreased malpractice activity. The proposed project is significant for two reasons: 1) there is little empirical evidence showing methods to improve perinatal patient safety, and 2) there are no scientific studies showing the relationship between improved perinatal patient safety and reduced obstetrical events, malpractice claims and payments.